MEDICARE: BOWYER PHYSICAL THERAPY INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT16172	FL

General Provider Information

NPI Number	:	1649209362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOWYER PHYSICAL THERAPY INC

Provider Business Mailing Address
First Line	:	100 YMCA LN
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33875-4352
Country	:	US
Telephone Number	:	863-382-2949
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 YMCA LN
Second Line	:
City	:	SEBRING
State	:	FL
Zip	:	33875-4352
Country	:	US
Telephone Number	:	863-382-2949
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KEITH ANTHONY BOWYER JR.
Credential	:	PT
Telephone Number	:	863-382-2949

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	04/19/2012

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